Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0100X | Gastroenterologist | 7079 | AZ |
NPI | 1043289341 |
---|---|
Provider Name | Richard A Manch |
First Address | Chandler, AZ 85224-4711 |
Second Address | Glendale, AZ 85306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 12/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
275108 | (05) | AZ |